Re: Responses to practitioner qualifications
Stan Lacount
Description
Collection
Title:
Re: Responses to practitioner qualifications
Creator:
Stan Lacount
Date:
4/21/2003
Text:
It occurs to me that it behooves the profession to develop a certification process that wraps it's arms around the entire prosthetic and orthotic field. Certification should include both orthotics as well as prosthetics in my humble opinion and quite possibly the field of physical therapy as well. For one to be a CP or CO without having the ability, licensure, or knowlege to fabricate, fit, and adjust othotic or prosthetic devices is rediculous. It's as foolish as blacksmith that only shoes cows.
This would mean a far more extensive educational and training process (4-6 years like other professional curriculums) but the upshot would be an end to the pathetic alphabet soup argument and a reduction in the need for redundant organizations like AAOP AOPA, etc. Teachers in the field should be required to have an advanced degree in the subject, but of course there are no advanced degrees in O&P as yet nor an ABET approved O&P undergraduate program to my knowlege. Perhaps Atlanta has one up and running now, but that isn't really the point. One would still have a P or an O major. Finally, Doctors, Insurance Companies, and Clients could be assured that they were truly getting professional services. That certification would be well worth having a Licence for.
Just my opinion
Stan
>
> From: chris huff < <Email Address Redacted> >
> Date: 2003/04/11 Fri PM 03:25:28 EDT
> To: <Email Address Redacted>
> Subject: [OANDP-L] Responses to practitioner qualifications
>
> Thank you for all that responded. Please lets put this issue to rest, as I do not want to stir up any debates or arguements. I just wanted to know if this was happening all over.
>
> Sincerely,
> Christopher Huff CO
>
>
> I just talked to some of the people at ABC. A CP can cast and deliver
> orthotics under the indirect supervision of a CO, so for example this CP
> works with a CO he can consult with, he would be able to, but if there is
> no CO in his company, then he could not. The CO would be ultimately
> responsible for the brace.
> This is the priviledging process that ABC talks about in the site
> accredidation manuel.
>
>
> CP's and anyone else for that matter can fit orthoses in states where there
> are no licensure requirements. Only a handful of states license orthotist
> and prosthetists. The catch is most insurance companies require
> ceritfication, although they tend not to distinguish between CO's and CP's.
> So they short answer is CP's can get away with fitting orthoses almost
> everywhere in the US. Is it ethical? No. Does it violate the ABC cannons of
> ethical professional behavior? Probably. Would a consumer, ill fit or
> injured have cause for action or complaint? Definetly.
>
> Historically this issue has been ignored in O&P. You have good reason to
> ask the question. In our facility CP's do not make or fit orthoses.
>
>
> If the state in which you live does not forbid it, this practice is
> certainly legal and ethical. If the state in which you live has a
> licensure program for P&O and the CP is a licensed although not a
> certified orthotist, this practice is also legal and ethical.
>
>
> I went through this with ABC about a year ago. Your answer depends on the
> state you are in. If their is licensure, then you must check with the
> requirements of the state and how its worded. If no licensure is needed,
> then there are no laws to disallow the sale/fitting of orthotic devices by
> anyone. You CANNOT represent yourself using the words orthotist, which is
> apparently associated only with a recognized certification board. As a CP,
> ABC did allow us to fit any device which was deemed off the shelf and not
> custom without any problem. They felt custom orthotic devices fell into a
> grey area because we are not specifically trained (don't have that special
> piece of paper) to do this job. Now with the recent Orthotic Fitters
> Program, you should call ABC to verify is you can still deliver off the
> shelf items or have to pay them money and take a class to get that special
> piece of paper so you can do this.
>
>
> Why would you think it illegal for a CP to provide
> orthotics when a non-certified, non-educated person
> can provide them? This is one reason why we need more
> states to adopt licensure laws, to protect the
> patients from being served by people who are not
> qualified by education and certification.
>
>
> It is very legal in the majority of states. As a matter of fact anyone can do it including the bum on the street.
>
> Ethical by who's standards. ABC has the highest standards and I do not recall seeing anything that says a CP can't do orthotics or that a CO can't do prosthetics.
>
> This has been a sore point with me for years also, and I have been trained as an orthotist as well at one of the universities but not something I do.
>
> I think if the C.P. does quality work, in a state where there are no legal
> barriers, then they should go for it! If we are really true to the patient
> and have their best interest at heart, then the person who does the best job
> should get the work, regardless of their credentials. That is my ethical
> take on the subject, of course in certain states/jurisdictions a C.P. cannot
> legally BILL for orthotic services. Maybe they can provide them for free
> though??? Anyone know???
>
>
> As experts in the art of pressure distribution, the mechanics of gait
> and the engineering involved in the manufacture of custom prosthetic
> devices, I personally feel confident in a prosthetists abilities in
> applying orthoses. Better a CP dispensing orthopedic items than a shoe
> salesman or an intake clerk.
>
> With the exception of states that require licensing, I don't think there
> are any legal restrictions on who can administer orthotic devices; and
> what's more--many products don't have clear labeling or guidelines as to
> whether or not they can be dispensed without a prescription and things
> like knee sleeves, ankle splints and tennis elbow straps are being sold
> over the counter without so much as recording the customers' names.
>
> As far as ethics are concerned, I didn't read through all the material,
> but what I did review on the ABC web site did not seem to indicate that
> it is forbidden for a practitioner to administer services outside the
> scope of their discipline, rather, it addressed the services that are
> administered from within their discipline.
>
> In a hospital, since most orthotic deliveries are billed to the hospital
> and covered under DRGs, Bundling or managed care capitation fees,
> provider credentialing is not an issue because services are being
> administered under a physician's care and the providers are not being
> reimbursed directly from the third party payor.
>
>
> Ultimately, I feel it is inappropriate for orthotic devices to be
> administered by anyone other than a CO, or someone under the direct
> (present in the room) supervision of a CO. This not being the majority
> rule at the present time, a CP is the next best thing to a CO in my book
> as long as we are forced to accept things as they are. If this
> individual happens to actually be knowledgable about orthotics and does
> a competent job, there may be nothing you can do...besides doing it
> better, that is.
>
>
> Hospitals that I have worked in require outside vendors (O&P-
> facilities) to be paneled by the hospital for hospital privilages.
> That includes fitting and delivery items in their proper category.
> So a prosthetist fits prosthetics and an orthotist fits orthoses.
>
>
>
> It is probably not ethical, given that the individual has not undergone the training to qualify for competency in another field. This is not to say that they are not capable, but it would be better if they focused on what they have been credentialed in. Depending on what state you live in, this may be illegal. You may want to contact the national office or the Department of Professional Regulation. I live in Florida and we have a licensure law here. I am curious to know more details of this matter if you would be interested in sharing more information.
>
>
> technically i wouldnt think so. it becomes a scope of practice issue and
> i do not think it is in their scope to cross discipline unless they are
> certified. but, unless you are in a state with licensure, there may be no
> tangible restriction. ethical: no, legal: grey area.
>
>
> Legal, depends on your state.
> Ethical. Canons say: NoGet more from the Web. FREE MSN Explorer download : <URL Redacted>
>
>
This would mean a far more extensive educational and training process (4-6 years like other professional curriculums) but the upshot would be an end to the pathetic alphabet soup argument and a reduction in the need for redundant organizations like AAOP AOPA, etc. Teachers in the field should be required to have an advanced degree in the subject, but of course there are no advanced degrees in O&P as yet nor an ABET approved O&P undergraduate program to my knowlege. Perhaps Atlanta has one up and running now, but that isn't really the point. One would still have a P or an O major. Finally, Doctors, Insurance Companies, and Clients could be assured that they were truly getting professional services. That certification would be well worth having a Licence for.
Just my opinion
Stan
>
> From: chris huff < <Email Address Redacted> >
> Date: 2003/04/11 Fri PM 03:25:28 EDT
> To: <Email Address Redacted>
> Subject: [OANDP-L] Responses to practitioner qualifications
>
> Thank you for all that responded. Please lets put this issue to rest, as I do not want to stir up any debates or arguements. I just wanted to know if this was happening all over.
>
> Sincerely,
> Christopher Huff CO
>
>
> I just talked to some of the people at ABC. A CP can cast and deliver
> orthotics under the indirect supervision of a CO, so for example this CP
> works with a CO he can consult with, he would be able to, but if there is
> no CO in his company, then he could not. The CO would be ultimately
> responsible for the brace.
> This is the priviledging process that ABC talks about in the site
> accredidation manuel.
>
>
> CP's and anyone else for that matter can fit orthoses in states where there
> are no licensure requirements. Only a handful of states license orthotist
> and prosthetists. The catch is most insurance companies require
> ceritfication, although they tend not to distinguish between CO's and CP's.
> So they short answer is CP's can get away with fitting orthoses almost
> everywhere in the US. Is it ethical? No. Does it violate the ABC cannons of
> ethical professional behavior? Probably. Would a consumer, ill fit or
> injured have cause for action or complaint? Definetly.
>
> Historically this issue has been ignored in O&P. You have good reason to
> ask the question. In our facility CP's do not make or fit orthoses.
>
>
> If the state in which you live does not forbid it, this practice is
> certainly legal and ethical. If the state in which you live has a
> licensure program for P&O and the CP is a licensed although not a
> certified orthotist, this practice is also legal and ethical.
>
>
> I went through this with ABC about a year ago. Your answer depends on the
> state you are in. If their is licensure, then you must check with the
> requirements of the state and how its worded. If no licensure is needed,
> then there are no laws to disallow the sale/fitting of orthotic devices by
> anyone. You CANNOT represent yourself using the words orthotist, which is
> apparently associated only with a recognized certification board. As a CP,
> ABC did allow us to fit any device which was deemed off the shelf and not
> custom without any problem. They felt custom orthotic devices fell into a
> grey area because we are not specifically trained (don't have that special
> piece of paper) to do this job. Now with the recent Orthotic Fitters
> Program, you should call ABC to verify is you can still deliver off the
> shelf items or have to pay them money and take a class to get that special
> piece of paper so you can do this.
>
>
> Why would you think it illegal for a CP to provide
> orthotics when a non-certified, non-educated person
> can provide them? This is one reason why we need more
> states to adopt licensure laws, to protect the
> patients from being served by people who are not
> qualified by education and certification.
>
>
> It is very legal in the majority of states. As a matter of fact anyone can do it including the bum on the street.
>
> Ethical by who's standards. ABC has the highest standards and I do not recall seeing anything that says a CP can't do orthotics or that a CO can't do prosthetics.
>
> This has been a sore point with me for years also, and I have been trained as an orthotist as well at one of the universities but not something I do.
>
> I think if the C.P. does quality work, in a state where there are no legal
> barriers, then they should go for it! If we are really true to the patient
> and have their best interest at heart, then the person who does the best job
> should get the work, regardless of their credentials. That is my ethical
> take on the subject, of course in certain states/jurisdictions a C.P. cannot
> legally BILL for orthotic services. Maybe they can provide them for free
> though??? Anyone know???
>
>
> As experts in the art of pressure distribution, the mechanics of gait
> and the engineering involved in the manufacture of custom prosthetic
> devices, I personally feel confident in a prosthetists abilities in
> applying orthoses. Better a CP dispensing orthopedic items than a shoe
> salesman or an intake clerk.
>
> With the exception of states that require licensing, I don't think there
> are any legal restrictions on who can administer orthotic devices; and
> what's more--many products don't have clear labeling or guidelines as to
> whether or not they can be dispensed without a prescription and things
> like knee sleeves, ankle splints and tennis elbow straps are being sold
> over the counter without so much as recording the customers' names.
>
> As far as ethics are concerned, I didn't read through all the material,
> but what I did review on the ABC web site did not seem to indicate that
> it is forbidden for a practitioner to administer services outside the
> scope of their discipline, rather, it addressed the services that are
> administered from within their discipline.
>
> In a hospital, since most orthotic deliveries are billed to the hospital
> and covered under DRGs, Bundling or managed care capitation fees,
> provider credentialing is not an issue because services are being
> administered under a physician's care and the providers are not being
> reimbursed directly from the third party payor.
>
>
> Ultimately, I feel it is inappropriate for orthotic devices to be
> administered by anyone other than a CO, or someone under the direct
> (present in the room) supervision of a CO. This not being the majority
> rule at the present time, a CP is the next best thing to a CO in my book
> as long as we are forced to accept things as they are. If this
> individual happens to actually be knowledgable about orthotics and does
> a competent job, there may be nothing you can do...besides doing it
> better, that is.
>
>
> Hospitals that I have worked in require outside vendors (O&P-
> facilities) to be paneled by the hospital for hospital privilages.
> That includes fitting and delivery items in their proper category.
> So a prosthetist fits prosthetics and an orthotist fits orthoses.
>
>
>
> It is probably not ethical, given that the individual has not undergone the training to qualify for competency in another field. This is not to say that they are not capable, but it would be better if they focused on what they have been credentialed in. Depending on what state you live in, this may be illegal. You may want to contact the national office or the Department of Professional Regulation. I live in Florida and we have a licensure law here. I am curious to know more details of this matter if you would be interested in sharing more information.
>
>
> technically i wouldnt think so. it becomes a scope of practice issue and
> i do not think it is in their scope to cross discipline unless they are
> certified. but, unless you are in a state with licensure, there may be no
> tangible restriction. ethical: no, legal: grey area.
>
>
> Legal, depends on your state.
> Ethical. Canons say: NoGet more from the Web. FREE MSN Explorer download : <URL Redacted>
>
>
Citation
Stan Lacount, “Re: Responses to practitioner qualifications,” Digital Resource Foundation for Orthotics and Prosthetics, accessed November 5, 2024, https://library.drfop.org/items/show/221056.
